Individual
DR. CHARLES B. CLARK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6025 METROPOLITAN DR, SUITE 205, BEAUMONT, TX 77706-2408
(409) 899-4999
(409) 899-3978
Mailing address
6025 METROPOLITAN DR, SUITE 205, BEAUMONT, TX 77706-2408
(409) 899-4999
(409) 899-3978
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
D9396
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0981946-01
—
TX
01
—
359865
MEDICARE PTAN
TX
Enumeration date
09/15/2006
Last updated
03/05/2015
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